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• Consensus:
– Encourage health care providers, health systems, health plans, and pharmacy
benefit managers to accelerate use of existing national standard
transactions for electronic prior authorization (i.e., National Council for
Prescription Drug Programs [NCPDP] ePA transactions and X12 278)
– Advocate for adoption of national standards for the electronic exchange
of clinical documents (i.e., electronic attachment standards) to reduce
administrative burdens associated with prior authorization
– Advocate that health care provider and health plan trading partners, such as
intermediaries, clearinghouses, and EHR and practice management system
vendors, develop and deploy software and processes that facilitate prior
authorization automation using standard electronic transactions
– Encourage the communication of up-to-date prior authorization and step
therapy requirements, coverage criteria and restrictions, drug tiers,
relative costs, and covered alternatives (1) to EHR, pharmacy system, and
other vendors to promote the accessibility of this information to health care
providers at the point-of-care via integration into ordering and dispensing
technology interfaces; and (2) via websites easily accessible to contracted
health care providers
Automation to Improve Transparency
and Efficiency